瑞舒伐他汀预处理对STEMI患者PPCI后心肌再灌注及迷走神经功能的作用

发布时间：2018-07-04 22:19

本文选题：心肌梗死 + 心肌再灌注　；参考：《重庆医学》2017年02期

【摘要】：目的探讨术前瑞舒伐他汀不同预处理对长期服用他汀药物的急性ST段型抬高心肌梗死(STEMI)直接直接经皮冠状动脉介入治疗(PPCI)患者心肌再灌注及迷走神经功能的影响。方法按是否起病前服用他汀类药物超过3个月,将170例首次STEMI患者分为长期他汀干预组、大剂量组和常规剂量组。术前、术后分别检测肌酸激酶同工酶MB(CK-MB)、肌钙蛋白T(TnT)、超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)及血脂水平;评价心肌再灌注情况;术后7、40d检测心率减速力(DC)、化学反射敏感性(ChRS);术后40d内观察主要心血管不良事件及药物不良反应的发生。结果术后TIMI TMPG 3级,RA(室速、窦缓、房室传导阻滞)发生,心电图抬高ST回落率术后及再灌注心律失常方面,长期他汀干预组与大剂量组均明显优于常规剂量组(P0.05);术后7、40d时,两组DC值、低风险值比例和ChRS值均较常规剂量组明显升高(P0.05),高风险值比例均较常规剂量组明显降低(P0.05)。在再发心绞痛、心力衰竭、严重室性心律失常(多形性室性早搏、非持续性室性心动过速)、心脏彩超左室射血分数指标方面,两组均优于常规剂量组(P0.05)。结论长期服用他汀药物病史患者术前瑞舒伐他汀10mg预处理,即可进一步提高STEMI患者PPCI后心肌再灌注水平,增加迷走神经活性,改善近期预后。
[Abstract]:Objective to investigate the effects of different preconditioning of resuvastatin on myocardial reperfusion and vagal function in patients with acute ST-segment elevation myocardial infarction (STEMI) treated with statin for a long time after direct percutaneous coronary intervention (PPCI). Methods 170 patients with STEMI were divided into long-term statin intervention group, high dose group and routine dose group according to whether to take statins for more than 3 months before onset. Before and after operation, the levels of creatine kinase isoenzyme MB (CK-MB), troponin T (TNT), hypersensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6) and serum lipids were measured, respectively. Heart rate deceleration (DC), chemical reflex sensitivity (ChRS) were measured at 7 ~ 40 days after operation, and major adverse cardiovascular events and adverse drug reactions were observed within 40 days after operation. Results after operation, TIMI TMPG grade 3 RA (ventricular tachycardia, sinus bradycardia, atrioventricular block), ECG elevation St lowering rate and reperfusion arrhythmias were significantly better in the long-term statin intervention group and the high-dose group than in the conventional dose group (P0.05), and at 740 days after operation, there was no significant difference between the long-term statin intervention group and the high dose group (P0.05). DC value, low risk value ratio and ChRS value of both groups were significantly higher than those of routine dose group (P0.05), and the proportion of high risk value were significantly lower than that of routine dose group (P0.05). In terms of recurrent angina, heart failure, severe ventricular arrhythmias (pleomorphic ventricular premature beats, unsustainable ventricular tachycardia), left ventricular ejection fraction of color Doppler echocardiography, both groups were superior to the conventional dose group (P0.05). Conclusion Preconditioning of recuvastatin 10mg in patients with long-term history of statin can further improve myocardial reperfusion, increase vagal nerve activity and improve short-term prognosis in patients with STEMI.
【作者单位】：广州军区武汉总医院心血管内科;
【基金】：武汉市中青年医学骨干人才培养工程(武卫生计生201477)
【分类号】：R542.22

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